I have concern for veterans and the cost of health care. I also have concern for road safety. I don’t think exempting VA health care providers from the National Registry of Certified Medical Examiners (National Registry) is a good idea. Below is my alternative. It addresses the concerns of health care cost for veterans, maintains the constancy and integrity of the National Registry system and maintains the ability to transfer medical certificate information electronically to the state driver’s licensing agencies, thus, eliminating the need for CMV drivers to take their records into the SDLA ( state driver’s licensing agencies) office.

I understand that some CMV drivers are veterans who qualify for Veterans’ Affairs (VA) Health Benefits, yet, are required to undergo a physical examination by a National Registry Certified Medical Examiner. I also understand that some of these drivers are concerned about the additional cost for the examination since few VA health care providers are listed on the National Registry. In addition, I understand that many drivers prefer to see their primary care provider for their FMCSA medical certificate. In the paragraphs below I address these concerns and offer my alternative.

I propose that congress draft and pass a bill that requires referral to the National Registry provider and reimbursement of costs for those veterans who are CMV drivers and qualify for VA benefits. This should be done if the VA health care center does not employ a certified medical examiner. This referral and reimbursement process is already utilized by the VA when a veteran needs care of a specialist not available at the VA Health center. My alternative does not set a precedent and it addresses the cost and accessibility of the National Registry certified medical examiners for veterans who qualify for VA healthy benefits.

My reasons for offering this alternative are listed below.

Veteran Health Care

1) The need for the National Registry

Prior to the establishment of the National Registry, many CMV drivers saw their primary care provider to obtain their medical certificates. Over time it was discovered that most primary care providers are not familiar with

a) the role and responsibility of a CMV driver

b) the difference between operating a CMV and automobile

c) the FMCSA regulations and guidance. Serious crashes involving loss of life resulted from improperly medically certified drivers. Thus, Congress mandated that the Agency develop a method for ensuring that health care professionals performing the physical examinations are trained and proficient in the requirements of driving. The National Registry Program was developed over a period of several years and was published for public comment as required. Thus public input was included.

2) Primary health care professionals qualifications.

Primary health care professionals as well as those listed on the National Registry are qualified medical professionals, licensed to practice in the United States. But, just as some medical professionals take courses and board certification examinations to become certified as a specialist (e.g. endocrinologist, cardiologist, etc.), so, too, health care professionals take the training and the tests to become proficient in transportation health, to become certified on the National Registry. The professionals on the National Registry understand the FMCSA regulations and can synthesize the driver’s medical information with the regulations and the ability to safely operate a CMV in interstate commerce. National registry Medical Examiners also contact and obtain information for the primary care provider as needed.

Several studies have shown that since primary care providers have a personal relationship with their patient they often will bend to the patient’s requests to help their patient receive a benefit. In the past, some of these primary care providers have issued medical certificates when the driver’s medical condition was not conducive to safe operation of a CMV in interstate commerce.

3) Inconsistency of driver qualifications.

Congressman Woodall’s bill exempts VA health care professionals from the National Registry and gives some CMV drivers the ability to see their primary care provider while others CMV drivers must go to a National Registry provider — so a double standard will be set and inconsistency will result.

Mr. Woodall’s bill also impacts the data entry system that electronically transfers medical certificate information to the SDLAs for CMV driver licenses. Drivers and SDLAs requested that driver medical certificates be electronically transferred from the Medical Examiner through the National Registry to the SDLAs. FMCSA just finalized a regulation to enable this function. If CMV drivers are examined and issued medical certificates for a medical provider not on the National Registry, the data transfer function will be circumvented and the driver will need to make the medical certificate into the SDLA. The electronic data transfer system will be adversely affected.

5) Veteran Affairs Health Care Clinics

VA Health Clinics are overwhelmed with numbers of veterans seeking care. This is well documented. Thus, it may be difficult for CMV drivers to get a timely appointment for a medical examination to obtain a CMV driver’s medical certificate. By utilizing a referral and reimbursement process, the VA Health center will minimize the number of patients to be seen at its facility and meet the CMV driver’s need.

I am concerned about veterans and all CMV drivers. But I am also concerned about the safety of our roads. . I believe veteran’s concerns can be integrated with concerns for the safety of our roads and integrated into the already existing system.

I recommend that you consider my ideas and take action writing to your congressman and to the House Transportation and Infrastructure Committee’s Subcommittee on Highways and Transit. To learn more about the committee and which congressman serves on it., go to: Transportation House

By: Elaine Papp

Elaine M. Papp RN MSN COHN-S CM FAOOHN
Elaine M. Papp has a broad range of occupational safety and health experience, from private industry to international organizations. A board certified occupational health nurse with experience working for regulatory agencies, Elaine is now offering her knowledge and experience in occupational and transportation health through her newly founded company, Health and Safety Works, LLC.
Prior to establishing her company, Elaine spent 7 years as the Division Chief of the Office of Medical Programs at the Federal Motor Carrier Safety Administration (FMCSA) where she gained extensive knowledge about the relationship between medical conditions, their impact on safe operation of commercial motor vehicles (CMV) and FMCSA regulations/guidance. Elaine was responsible for establishment of FMCSA’s National Registry of Certified Medical Examiners including the training and testing components and compliance assistance materials. She also lead the Agency’s effort to create the hearing and seizure exemption programs. Elaine oversaw a staff of 10 who offered compliance assistance to the public answering over 3000 telephone calls and 2000 emails a month. She also served on regulation writing teams, oversaw the research of various medical conditions and their relationship to safe operation of a CMV, developed the Medical Examiners Handbook as well as various outreach and training materials for medical examiners, drivers and motor carriers.
Prior to FMCSA, Elaine worked for the Occupational Safety and Health Administration (OSHA) in several capacities: analyzing legislation, writing Congressional testimony, regulations and compliance assistance materials, participating in on-site enforcement inspections, and conducting presentations on behalf of the Agency.
While at OSHA, Elaine was selected for the Executive Leadership Program (ELP) and spent a few months in Geneva Switzerland working with the World Health Organization and the International Council of Nursing (ICN) as part of the ELP development program. Elaine authored the International Council of Nursing’s (ICN) “Guidelines for a Health and Safety Program for Nurses” and a monograph entitled, “A Guide to Health Care Waste Management for Nurses.”
Prior to working for the government, Elaine had her own company working as an Occupational Safety and Health Consultant. She has also worked in private industry for TRW, a fortune 100 company, as a Senior Health and Safety Specialist. Early in her career Elaine worked in a variety of health care settings — intensive care units, doctor's offices, hospital, non-governmental organizations. and health policy groups. Thus, she has developed a broad perspective of health care in the US and has cashed to focus on employee/driver health and wellness.